Trials and tribulations we all have. The not-knowing of the future can create anxiety, distress and an unhealthy desire for chocolate. Some days, knowing what’s for tea can provide the only concrete grounding in an otherwise fluctuant universe. And along with that, the naming of things can sometimes be enlightening. So, for un-knowing, you could […]
Category: archimedes
Does fear of missing a diagnosis drive your every action?
If there was a chance that you missed a diagnosis about which you would be able to intervene 2:1,000 times, and that the test which could diagnose it cost about £3 and was minimally invasive – wouldn’t you be daft not to use it? Or would you think “what a waste of time!” and wonder […]
Strawberry stories
My mum insists that we, at home, always cut off the green bit & splice the strawberry in case it had a slug in it. For Ian Wacogne it’s sitting with his back against a radiator. Why? Well, in my case it’s so that you can’t eat a slug … that’s managed to get into […]
Quality Improvement: Why it’s not turfing the RCT to the long grass
We’ve started to publish a fair few quality improvement reports in the Archives recently, aiming for 1200 words, 5 references and a readable SQUIRE-compliant paper that gets across the key messages about how a #QI project was undertaken. These aren’t trials, don’t have control arms, and may suffer from significant publication bias. (It’s not surprising to […]
Subgroups and multiple analysis. Truth or herrings?
We recently published, in the F&N edition, a paper reporting an RCT looking at inhaled steroid in wee premature babies to see if the treatment reduced the incidence of death and chronic lung disease. Did we do a good job? The trial was prospectively registered, before enrolling patients, randomised and stated it was […]
Dethrone the “Landmark Trial”
There is a long honoured tradition in a number of specialities, and sub-specialities, of knowing The Landmark Trials. The studies that demonstrated that something works or that some method is better than another. But Landmark Trials are bunkum. […]
Overdiagnosis in paediatrics
WHY is the rate of admission for bronchiolitis skyrocketing? HOW CAN we combat this clearly terrible condition? Perhaps we can stop diagnosing it as worth of hospitalisation? […]
Basics: Blame it on me
In my clinical role, it’s fairly easy to take the blame for most bad things that happen to my patients. I give them cytotoxic chemotherapy (for good reason, honest) and it’s a group of substances that we label with TERATOGENIC! HARMFUL! QUITE BAD FOR YOU! tags a lot of the time. But how do we […]
How often can you cry “Wolf”?
The fable of the bored shepherd boy, alone on a hillside (except for the sheep – sheep don’t count as company*) waiting for something to happen, is one that I hope most of us know and can recount if needed at any dinner table. In my folk-recollections of the tale, it’s three times that the […]
How do health care teams talk about very-low-success interventions?
The situation is clear. The child has an illness which is very likely to end their life – and soon – in days, not months or years. They may be hooked to a ventilator, drizzled with inotropes, or osmosed. The health care team is talking – once again – about the outcomes and what we […]